Moving care to the community

An international perspective

16 December 2013
Updated December 2014. Moving care out of hospitals and into the community has been a UK wide priority for over a decade; however despite the government's commitment to invest in the community, there is a mismatch between reality and rhetoric. The RCN has worked closely with our sister nursing organisations in Canada, Australia, Norway, Sweden and Denmark to learn from their experiences relating to shift. This report sets out the current policies and initiative in the above-mentioned countries to move care closer to home; outlines the impact of these reforms on the nursing workforce; and offers recommendations for key stakeholders in the UK.

The RCN supports care being delivered closer to home where it is clinically appropriate and safe to do so. To effectively shift care into the community, hospital restructuring reforms should be implemented in parallel with community reinvestment programmes, and both sectors should collaborate with each other to address gaps in service provision as they emerge.

The RCN strongly believes that providers and commissioners of health care services must undertake robust workforce planning to reduce the likelihood of a diluted nursing workforce and inappropriate skill mix. The RCN has continuingly called for mandatory nurse to patient ratios and regulation of HCSWs, as there are sufficient reports into care failings that highlight the risks associated with poor workforce planning. The RCN views optimal staffing ratios and regulation of HCSWs as a prerequisite to safeguard the quality of patient care.

Nurses play a pivotal role in the delivery of clinically appropriate and safe care across the health and social care continuum. To build a sustainable community workforce, investments must be made to support, train and develop nurses to work in community, primary care and long-term care settings. The essential career pathway of community specialist practice (district nursing) must be reinstated and promoted to encourage knowledgeable and qualified specialist nurses to develop in leadership roles. New entrants into the nursing profession should also be exposed to community and primary care nursing as a career option equal to acute nursing practice.

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